| NPI | 1780614602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23493) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-01-18 |